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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Concomitant Radiocarpal Dislocations in Perilunar Injuries: Prevalence
Ian Mullikin, MD
SAMMC, San Antonio, TX

Hypothesis: Perilunar injuries have classically been described as occurring in a predictable mechanism of injury with sparing of the volar radiocarpal ligaments. At a Level 1 trauma center, a high incidence of combined perilunar injuries and radial carpal dislocations have been noted. We hypothesize that these injuries occur in a higher prevalence than previously thought and may challenge the currently accepted mechanism of injury and effect surgical outcomes.

Methods: We performed a retrospective review of adult patients that sustained a perilunar injury at our tertiary care center from January 2013 to January 2017. From this subset of patients we further identified those patients that sustained a concomitant radiocarpal dislocation confirmed intraoperatively. Various clinical and radiographic variables were evaluated to determine the outcomes of patients who sustained the combined injuries compared to those with an isolated perilunar injury.

Results: A total of 27 patients were identified as sustaining a perilunar injury during this period. Of these 27 patients 8 (29.6%) were also identified as having sustained a concomitant radiocarpal dislocation. Of these patients, 7 patients underwent lunate or perilunate reduction and fixation along with radiocarpal stabilization and 1 patient underwent acute proximal row carpectomy. Patients had variable outcomes with respect to pain, range of motion, and post-operative complications.

Summary Points:

In high-energy trauma, perilunar dislocations may result in concomitant radiocarpal dislocation which challenges the classic pathoanatomy of these injuries.

  • Providers should have vigilance for these uncommon combined injuries.

  • Patients with a perilunar injury should undergo volar and dorsal surgical approaches to identify and treat concomitant volar radiocarpal ligament disruptions given the prevalence of these rare combined injuries.

  • Salvage procedures such as scaphoidectomy with four corner arthrodesis and proximal row carpectomy should be performed with caution in the setting of incompetent volar radiocarpal ligaments.

    Level of Evidence: Level IV, Case Series
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